Citation

Gitajn IL, Reider L, Scharfstein DO, O'Toole RV, Bosse MJ, Castillo RC, Jevsevar DS, Pollak AN. J. Orthop. Trauma 2019; ePub(ePub): ePub.

Affiliation

University of Maryland R Adams Cowley Shock Trauma Center.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000001657

PMID

31868766

Abstract

OBJECTIVE: Evaluate the association between patient and center level characteristics and discharge to an inpatient facility versus home after treatment for lower extremity trauma (LET), as well as examine the variability in discharge disposition across clinical centers after controlling for these factors.

DESIGN: This is an analysis of data collected prospectively across five multi-center studies of extremity trauma. SETTING: U.S. Trauma Centers. PARTICIPANTS: Patients 18-80 years with HELET treated at one of 55 participating centers. MAIN OUTCOME MEASURE: Discharge disposition.

RESULTS: Among 2,365 patients treated at one of 55 centers across 13 states, 673 (28.5%) were discharged to an inpatient facility, and 1692 (71.5%) were discharged home. Individuals who were older, female, unmarried, insured, higher BMI, history of severe alcohol abuse, Gustilo type IIIB or IIIC open injuries, bilateral, spine and upper extremity injuries, higher ISS scores, or ICU stay were more likely to be discharged to an inpatient facility. Even after accounting for patient and center level characteristics, there was substantial variation in discharge disposition across centers (likelihood ratio test: p<0.001).

CONCLUSION: Variation in discharge disposition may represent a potential for improvement in resource utilization and cost savings. Further studies are needed to examine the relationship between utilization of post-discharge inpatient facility after trauma and outcomes. LEVEL OF EVIDENCE: III.

Language: en